[Diagnosis and treatment of secondary spine tumors]

The surgical results of the 63 patients with metastatic cancer of the spine, treated in Chiba University Hospital and Chiba Cancer Center in 1977-86, were analyzed. The location of the primary tumor were lung (30.2%), thyroid gland (14.3%), kidney (14.3%), breast (12.7%) and gastro-intestinal tract (9.5%). All patients had intractable pain, and 47 (76%) had neurologic deficit. 46 patients were treated with posterior procedure, 7 with anterior procedure and 10 with combined anterior and posterior procedure. Anterior and posterior stabilization using implants (instrumentation, ceramics, cement) were undertaken together with tumor resection and surgical decompression in past 10 years. In 21 patients treated with laminectomy only, 53% had pain relief, and 48% had improvement of neurologic deficit. In 42 patients treated with surgical decompression and stabilization, 78% had pain relief, and 54% had improvement of neurologic deficit. Surgical decompression should be undertaken before complete paralysis develop (degree B on Frankel classification). With multi-disciplinary treatment patients with metastatic cancer of the spine survived for a significantly longer time. In patients with neurological deficit but few visceral metastasis and in those with slow-growing tumor (thyroid cancer, breast cancer and kidney cancer) in which a survival time of longer than 6 months can be expected, operative intervention using advanced surgical technique the quality of the patient's life and let patients support themselves in ADL.